YOUNG OPTOMETRISTS


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  • 26 Jul 2020 9:28 PM | Anonymous

    Student's Corner is a new space which is designed to introduce some of the amazing Optometry Students - delving deep into their likes, dislikes, struggles and current mood. Introducing Jahin Tanvir! Our first student feature from the University of Canberra.

    Name: Jahin Tanvir

    Student Year/Workplace: 2nd year Optometry at the University of Canberra

    Favourite Disease: Retinopathy of Prematurity

    What about Optometry really grinds your gears? (if any!): That some people think that Optometrist just sell you glasses. 

    What drives your passion for Optometry? Being able to ensure an individual can relish the gift of sight. I don’t think anything beats you playing a role in someone being able to see better and experience the things they love with a clearer perspective. 

    Something you discovered about the uni not everyone may know? When they say, “uni is where you find yourself”. I had to be there first-hand to realise the gravitas of that phrase. Being in a school environment, you’re pretty much in a bubble and university really opens that up to so many opportunities.

    Would you rather be indoors or outdoors? I used to think I was inclined more towards indoors but being at home so much this year has shown me how much I yearn to be outdoors. Outdoors guy for sure!

    Something others may not know about you: Parallel to my academic inclinations in Optometry, I’m also a writer and it’s an area I want to pursue throughout my career. I want to promote the idea of ‘you are not limited by your degree’.

    What song do you play that instantly lifts your mood? Down by Jay Sean. Absolute classic!


  • 26 Jul 2020 9:13 PM | Anonymous

    Blue Blocking Lenses

    Blue Light and the Macula

    Studies have shown that by reducing blue-light transmission through blue blocking lenses by 50%, approximately 80% of photochemical damage to the retina could be reduced. 

    • However, it is important to remember that macula degeneration is a multi-factorial disease and there are other risk factors we could also recommend to our patients (e.g. diet, cease smoking, sunlight exposure) 

    Contrast and Asthenopia improvement

    The rationale behind blue blocking lenses for screen use is the improvement in contrast, improve visual comfort and cut down internal reflections and back surface reflections from the lenses thereby reducing glare. Blue wavelengths are the shortest wavelengths within the visible light spectrum and therefore most likely to scatter. 

    We also don’t know how much blue light needs to be removed to reduce asthenopic symptoms. As of current, the majority of blue coatings reduce blue light by roughly 10-25%. Optometrists can consider recommending blue blocking lenses to patients who are under high exposure to blue light rays from artificial and natural light sources, for example office workers behind screens and under fluorescent lights. 

    Circadian Rhythm 

    The scattering effect can cause glare and reduce contrast. Also, blue light may interfere with the body’s circadian rhythm; therefore exposure in the evening may potentially interfere with sleep. However, more and more we are exposed to artificial lights at night e.g. smartphones and tablet use before bed; and this is especially when the circadian system is most sensitive to light-induced phase delays. Studies have shown this can interfere with sleep and physiological processes, causing subjects to sleep later, reducing evening sleepiness, reducing in alertness the next morning and reducing melatonin secretion. 

    • Get patients to limit device use before bed. Turn on Bed Time Mode or Night Mode on their phone, which effectively diverts alerts, calls and messages to the next day so they are not tempted to check their phone during the night or after their prescribed bedtime. 

    Future Research 

    There is more research required, understanding that patients will need individualised solutions 

    • As always, carry out a full visual and binocular examination, taking into consideration the tasks the patient will be requiring visual aids for 

    Tips 

    Advice beyond blue blocking lenses that you could also recommend to your patients: 

    • Positioning of screens and ambient lighting 
    • Recommend your patients utilise rest breaks with prolonged computer use 
    • Good posture (feet flat, shoulders squared back) 
    • Consider a diet rich in vitamins and minerals that may aid eye health (link post) 
    • When using screens, turn the brightness to the lowest comfortable setting. Avoid using blue coloured backgrounds. Maintain an appropriate working distance from screens
    • Download applications which reduce the blue light emissions from the smartphone e.g. https://justgetflux.com/ or turn on Night Mode 
      • BenQ has developed a range of computer monitors which have inbuilt low blue light features 
    • If your car has blue light headlights, replace these with regular headlights as reflections from these lights may be harmful or cause asthenopic symptoms to other road users. 
    • Replace “daylight” or full-spectrum lights with warmer hues, such as red and yellow and avoid the cooler light hues. 

    References

    1. Blue light-absorbing intraocular lens and retinal pigment epithelium protection in vitro. Sparrow JR, Miller AS, Zhou J J Cataract Refract Surg. 2004 Apr; 30(4):873-8.
    2. www.cancercontrolsociety.com/bio2000/ott.html
    3. www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/May/blue-light-has-a-dark-side/
    4. Points de vue, International Review of Ophthalmic Optics, Essilor Issue 68
    5. http://ead.lib.virginia.edu/vivaxtf/view?docId=vcu-tm/vircuh00039.xml
    6. www.cclvi/org/contributions/effects1.htm
    7. www.mivision.com.au/2017/07/see-the-light-the-powerof- premium-lenses 
    8. www.mivision.com.au/2018/07/crystal-clear-premiumlens- coatings


  • 26 Jul 2020 9:07 PM | Anonymous

    Have you ever had a young patient with reduced visual acuities at distance and near that could not be explained by refractive error? You suspect that they’re malingering or wanting to have glasses? 

    Have you heard of Streff Syndrome? 

    Streff Syndrome, also known as non-malingering syndrome, has been described as a functional vision problem. It often involves reduced or blurred distance and near vision, poor eye co-ordination and eye movement, a reduction in visual field and a reduction in focusing.

    These symptoms are a result of anxiety or stress. Stress is a physical, mental or emotional reaction caused by a change that disturbs or interferes with the body’s normal equilibrium. It is often detected by teachers and parents due to a decline in academic performance, changes to attention and focus, or behavioural changes. Stress can impact visual health and function. Focusing can become difficult, and a tunnel vision effect can occur. 

    Streff Syndrome has more commonly been detected in females between 10-14 years of age. The condition is often self-limiting, but it is important to identify the stress causing the problem and taking the necessary steps to resolve it. 


  • 24 Apr 2020 1:54 PM | Anonymous

    Screen Time During Quarantine

    It seems like over-night covid-19 hit and suddenly, we are stuck at home with nothing but our screens to entertain us. While for our inner introvert this may be the ultimate dream it also has its pitfalls. Our social lives, work lives and CPD events have all moved online. With increased time at home & our lives now virtual, our screens are the portals to the world. Even before corona virus, Australians on average spent over 10 hours a day on screens. Also, many of us use multiple devices at the same time e.g. looking at your phone while also watching TV. It is only natural that screen use will increase in the current situation.

    While increased screen use will not damage your eyes, the increased demand on your eyes can have negative effects. Often the underlying cause is a borderline eye problem that has been exacerbated by the increased screen time. This is because the visual demands of computer work are unlike those associated with most other visual tasks. Most people will experience some form of Digital Eye Strain with sustained use of a digital device. It may present as eye strain, headaches/migraines, blurred vision, neck/back pain, dry eyes, and/or reduced concentration. You may also find it hard to switch off and have disrupted sleep.

    The good news is that there are 10 easy things that you can do to limit the negative effects associated with screen use:

    1. Up-to-date prescription: even small changes in prescription such as small amounts of undiagnosed & uncorrected hyperopia, astigmatism & binocular vision issues can cause computer vision problems. We should look after our own eyes the way we look after our patients and make sure that we get our eyes tested regularly.
    2. Optimized computer eyewear: for the greatest comfort at your computer, you will likely benefit from having customized computer glasses. As optometrists we are up to date with the latest lens technology and should use this to our advantage. 
    3. Take mini breaks: this helps to reduce focusing fatigue and accommodative spasm. The 20/20/20 rule is an easy way to implement this; every 20 minutes of screen time, take a 20 second break and look 20 feet (6 meters) away.
    4. Stay hydrated: make sure you are drinking water throughout the day to hydrate your body. Additionally, use lubricating eye drops to hydrate your eyes. Nutritional supplements such as omega 3 can also be beneficial in optimizing tear film quality.
    5. Blink: do not forget to blink. It is well known that people blink less frequently while working on screens which can cause dry & irritated eyes.
    6. Blue light protection: there is a link between eye strain & blue light emitted from digital devices. A blue light blocking coating can be applied to optical lenses &/or most devices have a built-in blue light filter than can be turned on.
    7. Optimize your workspace: make sure that you have appropriate lighting, font size and minimal glare. To reduce neck & back strain have the correct desk & screen height. If using a hand-held device use the knuckles-to-nose rule to ensure you are not holding the device too close. Put your knuckles on your nose & your device should not be held any closer than your elbow.
    8. Think outside the screen: go for a walk instead of watching TV, read an actual printed book, play a board game with your family, & remember that you do not always have to video call!!
    9. Screen free sleep: make the hour before going to sleep screen free & do not check your phone if you wake up during the night.
    10. Mental health check-in: with increased screen time, this usually translates to increased social media use. Be mindful of your mental health & take a break from social media if needed.

    While we navigate our new lives in isolation, it is more important than ever to stay connected online with our families, friends, & work. However, we must balance this screen use & try to keep things in moderation by using the simple tips out-lined above.

  • 15 Apr 2020 11:09 AM | Anonymous

    Guest Author, Lisa Siqi Feng

    Over the past months, we have been constantly bombarded with news of COVID-19 and its effects on the world around us as we knew it. Now, many of our colleagues are facing unprecedented difficult times. Thank you to Young Optometrist Lisa Feng for her efforts in writing the following article. 

    "If you had mentioned to me a few months ago about the coronavirus or COVID-19, I would have had very little idea of what it is and how it is going to affect me. Little did I know how rapidly it was all going to escalate and how much impact it was going to have on my personal and professional life as a young optometrist with a career that was just starting.

    It is difficult to mentally process the rapid and drastic changes which have happened to our world and lives especially when it continues to change day by day. Being a primary care practitioner coming into close contact with the patient, many of us had to grapple with the fear for our own health and safety. Concerns over finances also arise as the stability of our jobs is threatened, many face a drastic reduction in business, loss of jobs, closed business or reduced hours for full/part-time positions. I have felt the feelings of fear, concern, frustration, helplessness and have even questioned my choice of becoming an optometrist. As I begin to navigate through these emotions and talk to my peers, I have come to realise that these feelings are valid and that there are things we can do to navigate through this unique time.

    Have Hope
    In the midst of anxiety and uncertainty, have hope and know that this will not be forever. The last pandemic of this scale was the H1N1 swine flu in 2009 but most of us were not working adults or even recall the impact it had on our lives. Now that the world and the government have finally started to take this more seriously and act, people have come together (or rather stayed apart), all with the same goal to overcome this virus and return to our normal lives. Things may need to slow down or pause for a while but know that this will not be forever.

    Protect each other
    If work has been put on hold, then you are in the best position to stay safe and protect yourself and each other. Although you cannot actively help your patients as optometrists now, self-isolating as much as possible is the best thing you can do to protect each other. If the decision is to continue operating, then consider yourself a soldier on the front line and be vigilant about protecting yourself and the patients. Implement changes to the practice to keep social distancing within the practice and develop strict cleaning regimes amongst all staff. Have regular discussions with the practice owner, staff as well as colleagues who continue to work. Membership organisations such as Optometry Australia and from the optometry board of corporate companies have been regularly providing members with updates and offering support and advice.

    Seize Opportunity
    Our personal and professional lives have all been reduced, restricted and paused in one way or another. While it is important to mourn over what has been lost, this can also be a good opportunity to reflect and reset. Catch up on that much-needed sleep, use the extra time to take care of your mind and body. Video call a friend and ask how they are doing. Now there is finally time for the conference notes that you’ve been meaning to revise and catch up on CPD points. Start that side hustle and pick up hobbies that you’ve been wanting to try but never had the time. We can focus on all the things that have been lost but we can also put the energy into becoming better for this is all over.

    Know your options
    Every workplace is unique, and it is crucial to explore options with employment for now and the future. The situation is changing daily so stay alert but not anxious and communicate regularly with employers, colleagues and membership organisations such as Optometry Australia for advice on changes in optometry regulations, employment options and financial support. While Young Optometrists NSW/ACT cannot provide legal advice, they can provide support and redirect you to someone who can.

    I look forward to the day when this is all over so we can all return to work, fully appreciating all the things we took for granted before."

    Image may contain: 1 person, standing, ocean, sky, shoes, child, outdoor, nature and waterImage may contain: one or more people, ocean, sky, outdoor, nature and water

  • 15 Apr 2020 10:01 AM | Anonymous

    Now we've all got (a lot) of time of our hands, if your Instagram is anything like mine it's been inundated with the tastiest images of everyone's home cooking adventures. Here's a few below that are focussed on nutrient dense foods, which are great for eye health! 

    But firstly, what micro-nutrients are important for eye health?

    • Vitamin C - an antioxidant that we are unable to make or store. Therefore it's important we eat foods with Vitamin C numerous times throughout the day. Foods high in Vitamin C: red and green peppers, oranges, grapefruit, kiwifruit. Did you know, if you are allergic to latex you are possible allergic to kiwi as well?
    • Lutein and Zeaxanthin - a dietary carotenoid that has antioxidant properties and is  found in the macula and lens We are unable to make this and can only be absorbed through our diet. Foods high in lutein: Kale, spinach, collards (i.e. leafy green vegetables). Did you know you can eat wild dandelion greens? (Just make sure they're free of pesticides!)
    • Omega 3 fatty acids - Three main fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is through diet that we are able to practically increase these levels. Foods high in Omega 3: cold-water fish, flaxseed, chia seeds, walnuts, soybean oil, certain eggs and yoghurt. Did you know, because chickens are fed flaxseed in their feeds, their yolk contain DHA - so don't avoid the yolk! 
    • Beta-carotene - an antioxidant essential for maintaining the health of our eyes, skin, mucous membranes and immune system. Foods high in beta-carotene: peppers, carrots, sweet potatoes. Did you know the carotene comes from the Lain word for carrot?
    • Others: Vitamin A, Vitamin D, Vitamin E, Zinc, Selenium and others 

    Whilst there are many multi-vitamins on the market, it is best if you can absorb your nutrients through your diet! Eat your vegetables both raw and cooked, for example if you look at orange peppers, you can more readily absorb Vitamin C eating then raw, whilst more easily absorb Zeaxanthin eating them cooked. 

    SALMON POKE BOWL RECIPE

    • 500g diced salmon 
    • 1/4 cup soy sauce
    • 1 tablespoon rice wine vinegar
    • 1 teaspoon ginger (grated)
    • 1/2 teaspoon garlic (minced)
    • 3 green onions (chopped, thinnly)
    • Cooked rice (brown, sushi, white, whatever floats)
    • 1 cup leafy greens 
    • 4 radishes (thinnly sliced)
    • 1 avocado (cubed)
    • 1 sweet potato (cooked, cubed)
    • 2 carrots (grated)
    • Black sesame seeds
    1. In a medium sized bowl, combine soy sauce, sesame oil, rice wine vinegar, ginger, garlic, and green onions. Stir well to combine. Add fresh, cubed salmon and marinate for about 30 minutes in the refrigerator.
    2. Arrange brown rice, leafy greens, radishes avocado, carrots and salmon on top. Sprinkle black sesame seeds for a bit of class. 

    Blood Orange Poke Bowls with Quinoa Speckled Rice & Sea Lettuce ...

    Note: you can substitute the vegetables for others things in your fridge, try: peppers, collards, kale etc. 

    GREEN SMOOTHIE

    Ingredients: 

    • 1 ripe apple (peeled or chopped)
    • 1 kiwi fruit 
    • 1 cup kale
    • 1 carrot
    • 1/2 cup orange juice
    • 1/2 cup cold water
    • 6 ice cubes
    • 1 tablespoon ground flaxseeds

    1. Add all the ingredients in a blender and blend for about 30-60 seconds or until smooth. Enjoy! 

    Farm Fresh To You - Recipe: Refreshing Kiwi, Apple and Fennel Juice

    • Calories771
    • Fat52.54g
    • Saturated fat10.14g
    • Trans fat
    • Carbs24.33g
    • Fiber10.45g
    • Sugar7.19g
    • Protein53.1g
    • Cholesterol124.74mg
    • Sodium1950.2mg
    • Nutritional Analysis per serving(2 servings)Powered by

    seedy pancakes

    Ingredients: 

    • 3 cups oats 
    • 2 teaspoon baking powder  
    • 1 tablespoon baking soda
    • 1 teaspoon Salt
    • 2 tablespoon chia seeds2 tablespoon flaxseed meal 
    • ¼ cup maple syrup
    • 1 egg (50 g)
    • 1 teaspoon Vanilla Extract (5 g)
    • 1 ½ cups milk (cows, almond, oat - any is fine)
    • Spray of cooking oil 
    1. Blend 2 cups of rolled oats until it becomes a flour (around 30 seconds).
    2. To the oat flour, add in baking powder, baking soda, salt, chia seeds and flaxseeds. Pulse to combine.
    3. Add in the remaining cup of rolled oats, maple syrup, egg, vanilla extract and milk and blend until well combined. 
    4. Heat the pan on medium, add a spray of cooking oil. Add 1/4 cup of batter and cook until the edges begin to set and you see bubbles in your pancakes. Flip and continue to cook on the second side 2–3 minutes more. Serve warm with a sprinkle of maple syrup and nuts!

    Oatmeal Banana Pancakes with Cardamom, Pecans, Coconut and Maple ...

    If you try any of these recipes, make sure you tag us @yoptoms in your creations! 

  • 5 Apr 2020 10:26 PM | Anonymous

    If you told me 3 months ago that I would be unemployed and had to move back in with my parents, I wouldn't have believed you. But hey, here we all are! Money's tighter, budgets are smaller but these are a few financial tips that could help;

    Disclaimer: We strongly advise you to speak to your banks, lenders, legal advisor and/or accountant. This information is not to be interpreted as constituting professional advice and YO are not liable for any income loss taken from above advice. 

  • 5 Mar 2020 8:39 AM | Anonymous

    Our 'Unconventional Optometrist' column is where we chat to optometrists who are a bit out of the ordinary! Do you know anyone who we should feature? Let us know!

    Introducing Kevin La, a young optometrist who has followed his passion of introducing delicious foods from around the world and now runs a succcessful Instagram page. Read on to find out more about him. 

    Tell us a little bit about yourself

    Hi, I'm Kev! I'm an optometrist in my second year out, working in the Greater South West of Sydney. In my time off, I search for places to eat really good and authentic foods from cuisines around the world and write about them.

    Where can we follow you?

    Find me at @sydneyfoodboy on instagram!


    How did you get into what you’re doing in your time outside optometry?

    Well, I love to travel. It gives me so much joy to hop off a plane somewhere to immerse yourself in a rich culture with a completely different way of life. And one of the things I definitely look forward to most is trying all of the amazing food that each new place has to offer!

    I think we can all agree that working everyday is a little less exciting than that. On my last trip out, I wondered - how can I make everyday feel like a holiday?

    We’re lucky enough to live in Sydney, one of the cultural capitals of the world. So many people from all walks of life have come together to call one place home, meaning there is a world of different flavours waiting to be tried around Sydney. So that’s when I started on my quest and started writing about it!

    Tell us about one of your most memorable food experiences

    I was walking down the quiet-end of Liverpool and noticed a small, bustling eatery. People were coming and going with huge bags of takeaway containers to feed their families. With Lebanese cuisine being one of my favourites, I was so intrigued. I had to sit down for a meal.

    The hummus and falafel I tried there turned out to be amazing - some of the best I’ve eaten. Turns out that the restaurant was family-run and has been well-known in Liverpool’s Lebanese community for years. I read somewhere that the falafel recipe has been passed down a few generations too. We’re definitely lucky to be able to have that and many other food experience at our doorsteps!


    Do you find it easy to juggle your optometry career and your other passions?

    I find that searching for and writing about good food doesn’t take much effort from me! Before I started the IG page, you'd find me chatting away about food to my friends in my spare time anyway… or even to patients in the consult room ha! Food is a love shared by many and you can really talk to anyone for ages about the great food they’ve eaten. Because of this, it was a hobby that I easily translated into a passion project outside of work.


    Does time away from optometry help you appreciate it more? 

    I would say so. I love being an optometrist. We help people to see again, and we improve people’s lives because of it! Even if you don’t see it, you’re making a very positive impact on the world as an optom.

    I’ve seen a few of my peers become burned out from their jobs though. It’s understandable. It can get stressful, especially if you work in a practice with a high volume of patients. Being a guy that finds it really hard to stand still, I definitely didn’t want to go through that. Starting @sydneyfoodboy allowed me to pursue another love of mine and I would say I’ve enjoyed life more, both within and outside of work, since. 

    Do you have any advice for young optometrists out there who would like to pursue their passion but haven’t quite gotten started?

    You’ve just gotta do it! If you have something that you’ve wanted to pursue in the back of your mind, you should get out there and turn that thought into action! You won’t know if you’ll be successful or not until you try. You only have one life, so you have to make sure that you do everything in your power to enjoy every single day of it.



  • 20 Jan 2020 9:29 PM | Anonymous

    Student's Corner is a new space which is designed to introduce some of the amazing Optometry Students - delving deep into their likes, dislikes, struggles and current mood. And although we've called it Student's Corner, our first guest not-so-student anymore. Keep scrolling to read more about 2019 UNSW Optometry Society President: Ivy Kol.

    What is your favourite Disease?

    Microbial keratitis - it's the first red eye I ever saw!

    What about Optometry really grinds your gears? 

    When a patient is non-compliant with your treatment and then returns for the review complaining about the same issue.

    What drives your passion for Optometry?

    I really enjoy solving a person’s problem and seeing the positive impact on their life. It gives me a lot of personal satisfaction and is what keeps me motivated! 

    Something you discovered about the uni not everyone may know? 

    The structure at the top of the main walkway (where Scientia is) is designed to look like an open book   

    Would you rather do 100 body-weight squats or walk to and back from Village Green to Sir John Clancy?

    Walk to and back from Village Green to Sir John Clancy - so I can get a Stockmarket salad too 

    Something others may not know about you?

    I studied Exercise Physiology for a year before transferring into Optometry

    What song do you play that instantly lifts your mood?

    Sunflower by Post Malone

  • 20 Jan 2020 9:09 PM | Anonymous

    In Orthokeratology, Axial, Tangential, Refractive and Elevation plots have different roles

    • Axial: better to assessing treatment zone size and refraction change achieved
    • Tangential: better for assessing centration and to assess seal of lenses overnight. It also assesses the position of the lens on the closed eye environment, for example the patient had a corneal scar, this plot may be ideal as it draws data at a 90 degree tangent to the surface. The tangenital map also helps us assess the effect of corneal reshaping.
    • Refractive Power: better for assessing treatment zone size and quality of vision. Note: the more consistent or uniform the power, the better the quality of vision. This is not used independently, as it does not give us information  on curvature or size and shape of the corneal surface.
    • Elevation: height of the corneal surface compared to "best fit sphere" (in microns). Corneal elevation above the reference sphere is denoted in positive microns and is red, whereas blue shading denotes the corneal surface is below the reference sphere and is measured in negative microns. This may be helpful in predicting areas of excessive bearing (red or positive microns) or pooling (blue or negative microns).

    We need accurate topography maps to predict corneal sag for an accurate lens fitting.  Maps should be taken before and after lens wear so we can compared the changes, and use the subtractive function/compare function on the topographer to view this.

    Displays

    • Single View: This shows a single exam for the selected patient, a good tool for baseline screenings
    • Difference/Subtractive/Compare Display: This shows the difference between two exams, for the same eye. It subtracts each measured point from one map to another. Flatter areas are displayed in cooler colours e.g. blues, and areas of steepening are displayed in warmer colours e.g. reds.

    For example:


    • Tangential Subtractive Plot:
      • A big red ring appears here unlike in axial. This will tell you if the lens is sealing off at 360˚. Make sure that the ring lines over the pupil properly.

    • Axial Subtractive Plot
      • Look at the blue zone to assess size of treatment zone, whether it covers all the pupil and what the refraction change is

    Potential Fitting Outcomes


           Bulls Eye result:  

    When the sag of the cornea is predicted correctly by the topographer and the sag of the lens matches appropriately


           Smiley Face

    When the sag of the cornea is UNDERESTIMATED by the topographer and the sag of the lens is too shallow for the cornea, so that it touches centrally and then rides high on the eye overnight.


           Central Island

    When the sag of the cornea is OVERESTIMATED by the topographer and the sag of the lens is too deep for the cornea, so that instead of flattening the cornea centrally, it actually steepens it.


           Frowny face

    When the alignment curves on the edge of the lens are too TIGHT and the lens drops LOW in the closed eye environment (the sag does not matter in this case). 

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